Tekrarlayan Hırıltılı Solunumu Olan Çocuklarda Atopi Sıklığı

Year 2009, Volume: 3 Issue: 4, 10 - 15, 01.04.2009

Cem Hasan Razi Koray Harmancı Gonca Yılmaz Rahime Renda Okan Akın

Abstract

Giriş ve Amaç: Altı yaş altında gerçek astım tanısını koymak bu yaş grubunda hırıltıyla ilişkili değişik fenotipler nedeni ile zordur. Bu çalışmanın amacı 6 yaşından küçük çocukların astım tanısı koyarken atopik durumlarını belirlemektir.Bulgular: Bu çalışma Keçiören Eğitim ve Araştırma Hastanesi Çocuk Allerji Polikliniğinde gerçekleştirildi. Çalışmaya 2 yaşından önce hırıltısı başlamış ve en az 3 kez hırıltılı solunum sıkıntısı atağı geçiren toplam 236 çocuk (150 erkek,% 63.6) alındı. Ortalama yaşları 39.7±20.1 aylık olarak bulundu. Tekrarlayan hırıltılı solunumla gelen bu çocuklar geçici hırıltı, atopik hırıltı ve Nonatopik hırıltı olarak sınıflandırılmıştır.Sonuçlar: Bu çalışmada 3 farklı hırıltı fenotipi belirlendi. Nonatopic viral hırıltı (n:112, %47.5), Atopik hırıltı (Astım) (n:94, %39.8) ve Geçici hırıltı (n:30, %12.7). Astımlı çocuklar arasında (n:94), 69 hasta (%73.4) atopik olarak bulundu. Tüm çocuklar arasında IgE değeri >100 IU/ml olan 39 hasta (%83) astım tanısı alırken, (p<0.001) IgE değeri <100 IU/ml olan 55 (% 29.1) hasta astım tanısı aldı (p<0.001).Sonuç: Bu çalışma okul öncesi astımlı çocukların 3/4’ünün atopik olduğunu ve bu çocukların %83 ünde IgE değerinin >100 IU/ml üzerinde olduğu gösterilmiştir. Deri testi ve IgE gerçek astımlıları tanımlamamız bu yaş grubunda steroid tedavisine cevap verecekleri ayırt etmemize yardımcı olabilir

Keywords

Hırıltı, atopi, çocuk, total IgE

ATOPY FREQUENCY IN CHILDREN WITH RECURRENT WHEEZING

Abstract

Background: It is difficult to diagnose real asthma in children under 6 years of age because of different phenotypes of wheezing related disorders in this age group. Objective: The purpose of this study is to determine atopic status of children under 6 years of age in diagnosing real asthma.Methods: This study was performed in the outpatient clinic of Pediatric Allergy Department in Keçiören Education and Training Hospital. Children who had first wheezing episode before 2 years old and at least 3 episodes of wheezing were included in this study. A total of 236 children (150 boys, 63.6%) with a mean age of 39.7±20.1 months were included in the study. The children admitted with recurrent wheezing were classified as transient wheezing, atopic wheezing and nonatopic wheezing.Results: Three different wheezing phenotypes were identified in this study: nonatopic viral wheezing (n:112, 47.5%), atopic wheezing (asthma) (n:94, 39.8%) and transient infantile wheezing (n:30, 12.7%). The ratio of atopic children was 73.4% (n:69) among asthmatic 94 children. The ratio of children whose IgE levels were >100 IU/ml and diagnosed asthma was 83% (n:39), among all of the children (p<0.001). However, there were 55 children (29.1%) whose Ig E levels were <100 IU/ml and diagnosed asthma (p<0.001). Conclusion: This study demonstrated that ¾ of preschool asthmatic children had atopy and 83% of these children had IgE levels >100 IU/ml. Skin prick test and IgE should be helpful to identify real asthmatics who will respond to steroid treatment in this age group

Keywords

Wheezing, atopy, children, total IgE

References

• Martinez, FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six years of life. N Engl J Med 1995;332:133-138.
• Illi S, von Mutius E, Lau S, Nickel R, Niggemann B, Sommerfeld C, Wahn U; Multicenter Allergy Study Group. The pattern of ato- pic sensitization is associated with the development of asthma in childhood. J Allergy Clin Immunol 2001;108:709-714.
• Szefler SJ. The natural history of asthma and early intervention. J Allergy Clin Immunol 2002;109:549-553.
• Warner JO, Götz M, Landau LI, Levison H, Milner AD, Pedersen S, Silverman M. Management of asthma: a consensus statement. Arch Dis Child 1989;64:1065-1079.
• Bush A. Classification of phenotypes. Ped Pulmonol 2004;26 :30
• Kurukulaaratchy RJ, Matthews S, Arshad SH. Does environment mediate earlier onset of the persistent childhood asthma phenoty- pe? Pediatrics 2004;113:345-350.
• Xuan W, Marks GB, Toelle BG, Belousova E, Peat JK, Berry G, Woolcock AJ. Risk factors for onset and remission of atopy, whe- eze, and airway hyperresponsiveness. Thorax 2002; 57:104-109.
• Morais-Almeida M, Gaspar A, Pires G, Prates S, Rosado-Pinto J. Risk factors for asthma symptoms at school age: an 8-year pros- pective study. Allergy Asthma Proc 2007 ;28:183-189.
• Ramsey CD, Gold DR, Litonjua AA, Sredl DL, Ryan L, Celedón JC. Respiratory illnesses in early life and asthma and atopy in childhood. J Allergy Clin Immunol 2007;119:150-156.
• Almqvist C, Li Q, Britton WJ, Kemp AS, Xuan W, Tovey ER, Marks GB; CAPS team. Early predictors for developing allergic disease and asthma: examining separate steps in the “allergic march”. Clin Exp Allergy 2007;37:1296-1302.
• Sporik R, Henderson J, Hourihane JO. Clinical Immunology Re- view Series: An approach to the patient with allergy in childhood. Clin Exp Immunol 2009;155:378-386.
• Stein RT, Martinez FD. Asthma phenotypes in childhood: lessons from an epidemiological approach. Ped Respir Rev 2004;5:155
• Castro-Rodriguez JA, Holberg CJ, Wright AL, Martinez FD. A Clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med 2000;162:1403
• Covar RA, Spahn JD. Treating the wheezing infant. Pediatr Clin N Am 2003; 50:631-654.
• National Asthma Education and Prevention Program.Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma Update on Selected Topics 2002. J Allergy Clin Immunol ;110:141-219.
• Moss MH, Gern JE, Lemanske RF. Asthma in infancy and child- hood. In: Adkinson NF. (Eds.) Middleton’s Allergy Principles& Practice. Mosby, Philadelphia 2003; 1225-1255.
• Fahy JV, O’Byrne PM. “Reactive airways disease” A lazy term of uncertain meaning that should be abandoned. Am J Respir Crit Care Med 2001;163:822-823.
• Delacourt C, Labbe D, Vassault A, Brunet-Langot D, de Blic J, Scheinmann P. Sensitization to inhalant allergens in wheezing in- fants is predictive of the development of infantile asthma. Allergy ; 49: 843-847. Cullinan P, MacNeill SJ, Harris JM, Moffat S, White C, Mills P, Newman Taylor AJ. Early allergen exposure, skin prick responses, and atopic wheeze at age 5 in English children: a cohort study. Thorax 2004;59:855-861.
• Song CH. Skin Sensitization in asthmatic children less than 36 months of age. Ann Allergy Asthma Immunol, 1997;79: 273
• Wever-Hess J, Kouwenberg JM, Duiverman EJ, Hermans J, Wever AM. Prognostic characteristics of asthma diagnosis in early child- hood in clinical practice J Acta Pediatr 1999;88:827 – 834.
• Chan EY, Dundas I, Bridge PD, Healy MJ, McKenzie SA. Skin- prick testing as a diagnostic aid for childhood asthma. Pediatr Pul- monol 2005; 39: 558-562.
• Kotaniemi-Syrjänen A, Reijonen TM, Romppanen J, Korhonen K, Savolainen K, Korppi M. Allergen-Specific immunoglobulin E antibodies in wheezing infants: the risk for asthma in later child- hood. Pediatrics 2003;111:255-261.
• Devenney I, Fälth-Magnusson K. Skin prick tests may give gene- ralized allergic reactions in infants. Ann Allergy Asthma Immunol ;85:457-460. Ménardo JL, Bousquet J, Rodière M, Astruc J, Michel FB. Skin test reactivity in infancy. J Allergy Clin Immunol. 1985;75:646-651.
• Bodtger U, Jacobsen CR, Poulsen LK, Malling HJ.Long-term re- peatability of the skin prick test is high when supported by history or allergen-sensitivity tests: a prospective clinical study. Allerqy :58:1180-1186.